Why America Is Losing to COVID-19

There is a very simple explanation for why the COVID-19 outbreak has exploded in the United States. Unlike China, Singapore, and South Korea, the Trump administration has not even bothered to pursue widespread testing, contact tracing, and mandatory two-week quarantines for at-risk individuals.

NEW YORK – Kentucky Senator Rand Paul’s behavior over the past two weeks is exactly what’s wrong with America’s response to COVID-19. Paul has a compromised lung, so he decided that he should be tested for the disease out of an abundance of caution. From the time of his test until he was confirmed positive six days later, Paul did nothing to protect those around him. On the contrary, he met with other senators, cast votes on the Senate floor, played a round of golf at a private club, and even squeezed in a few laps at the Senate pool.

In the countries that have contained the coronavirus outbreak, such irresponsible behavior has not been tolerated, and even could have landed Paul in jail. As a physician (ophthalmologist), he, more than anyone, should know that if he was concerned enough about COVID-19 to be tested for it, he should have been equally concerned about the risk he was posing to others.

Containing the transmission of any infectious pathogen – especially one as contagious as COVID-19 – requires aggressive action. Defensive moves like closing businesses or social distancing are effective only when combined with rigorous, systematic efforts to get ahead of the spread of the disease.

In Singapore, South Korea, and other countries that have stanched the spread of the coronavirus, public-health authorities have followed a simple process. First, widespread testing has identified those who are infected even before they show symptoms (which many never do). Then, aggressive contact tracing has identified everyone with whom the infected person has interacted. Finally, everyone identified has been subjected to a mandatory 14-day quarantine.

This process not only contained the outbreak; it also avoided some of the extreme lockdown measures used elsewhere. Success lies in an uncompromising approach involving mass testing, contact tracing, and selective quarantining – all of which the US has failed to do.

In Singapore, the moment a person tests positive for COVID-19, a team of contact tracers is deployed. Someone sits with the patient for hours asking where he has been and with whom he has been in contact in the previous days. Others track down names, phone numbers, addresses, and anything else the patient can tell them that might help identify more positive cases.

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The team then delivers its findings to the Ministry of Health, which corroborates the information through phone calls, CCTV footage, and traditional detective work like reviewing retail receipts or checking rideshare apps to find drivers and passengers who might have interacted with the patient.

Once the list of potential contacts is known, everyone on it receives a call, and those most at risk of having been infected are required – not asked – to quarantine themselves for 14 days. Depending on the closeness of the contact, some are moved to a secure quarantine facility, whereas others may be permitted to remain in their homes.

Earlier this month, a close friend of mine returned from Europe to Shanghai and lived through the quarantine experience. Three days after arriving in China, he received calls from the police, the Shanghai Municipal Center for Disease Control and Prevention (CDC), and the district CDC telling him that a passenger on his flight had tested positive. My friend and his wife were then put into controlled quarantine, in a hotel that had been converted for the purpose. They resided in separate rooms, received three meals a day (along with other amenities), and were prevented from leaving until 14 days had passed since the point of initial contact on their flight.

In China, quarantines are monitored through an app. Everyone receives a unique QR code showing their status – green if you’re clear of infection, yellow if you’ve been instructed to stay indoors, red if you are under quarantine. If you’re roaming the streets and your QR code flashes red, you will immediately be moved back to quarantine, or else you may face fines or jail time.

Singapore has taken this technology even further, launching a new TraceTogether app that people can download to help protect themselves and those around them. If a user passes within two meters of someone who is found to be infected, the app immediately notifies the user of the risk.

Since late January, when Singapore reported its first case of COVID-19, more than 6,000 people have been identified through contract tracing and put into proactive isolation and quarantine. Owing to these efforts, infections have been contained, hospitals have not experienced a major surge in new patients, and only three people have died of the disease.

By contrast, although the US has many of these methods at its disposal, it has failed to deploy them effectively. The Centers for Disease Control and Prevention has trained more than 3,600 disease detectives who are skilled in identifying those infected, tracing their history of contacts, and mitigating the wider risk to the community. But they have been unable to do their jobs, owing largely to early testing failures, which still have yet to be resolved.

Contact tracing is costly and time-consuming even in the best of times, when an outbreak is still small. With large outbreaks that have gone undetected because of a lack of tests, it becomes nearly impossible logistically.

But failure must not be allowed to follow failure. Tests are finally becoming available to more Americans. Widespread testing, together with exhaustive contact tracing and selective quarantines, can still help us wrestle the outbreak back under control. As Paul himself said when defending his reckless behavior, “America is strong. We are a resilient people, but we’re stronger when we stand together.” True, but we are stronger when we stand together and act responsibly.

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So easy to make sweeping statements about US failures without considering any facts. The Asian 4 (HK, Sing, Taiwan and Korea) have indeed done very well. They had the advantage of being caught in SARs, Avian and Porcine flu (all from China)over the past 20 years. This spurred them to develop pandemic emergency preparations including Korea building a large hospital just for this type of crisis. China does indeed have a pretty good App but then again since it monitors its citizens everywhere it can make it work. Contrary to the author's casual suggestion the US could have a similar App, it has nowhere near the same available data collection and would face huge privacy issues if it tried to. It is now widely accepted that China understated infections and deaths by a very large margin.Testing has clearly been a major failure but then again China had disastrous testing and is still flip flopping on the results and the effectiveness if the tests. It has also been exporting defective kits to Europe.....Finally, just how badly is the US doing? Western Europe has about the same population. It has nearly 500k infections and 50k deaths. With a couple of exceptions it is testing in absolute numbers no more the the US and perhaps less. The US has 340k infections but far fewer hospitalizations and deaths. As Cuomo has commented, NY is testing so many it is hardly surprising its numbers are high but the critical list is lower as a percentage compared to Europe. We will not know until it is over but at this rate the muddled, poorly coordinated US effort seems to be having now worse an outcome and could end up significantly better.

If Paul got tested out of an "abundance of caution" due his medical condition and had no other symptoms and no reason to believe his probability of infection was any greater than those around him, why would he have changed his behavior beyond what others around him were doing?

There's no reason to "defend" Paul here, but I don't get the basis for the accusation. Am I missing something? Did he have a reasonable basis to suspect he had a higher risk of infection? Did he engage in behaviors that were outside the norm in his cohort?

However, once an epidemic has been allowed to spread beyond a certain point, your trained contact tracers become overwhelmed and cannot stay ahead of the curve. Whether IT solutions can solve this bottleneck while respecting privacy is still an open question. The alternatives are blunt and wasteful: universal social distancing, lockdowns, or just letting the virus rip.

The window of opportunity was wasted in the UK and USA. But even in Germany, which has tested but not traced as extensively, nothing like the successes of Singapore and Taiwan have been achieved.

William A. Haseltine condemns Kentucky Senator Rand Paul’s recklessness in recent weeks, which he sees as an explanation why COVID-19 is rampaging in the US. Paul was worried enough about being exposed to the virus, since he had a procedure last year to remove a damaged part of his lung. So he insisted on getting a still-hard-to-obtain test out of “an abundance of caution.” But while he was waiting for the results, he decided to keep going about his business – casting votes on the Senate floor, going to group lunches with his Republican colleagues, taking the Capitol elevators, talking with reporters, playing golf at a private club, working out in the still-open Senate gym, and doing laps in the pool there etc. In the Senate, the average age is 62.9. There are six senators in their 80s. Some senators have close family members with underlying conditions that make them especially susceptible to the virus, such as Utah’s Mitt Romney, whose wife has MS.“From the time of his test until he was confirmed positive six days later, Paul did nothing to protect those around him,” inadvertently spreading the virus around the Capitol. “As a ophthalmologist, he, more than anyone, should know that if he was concerned enough to be tested for the virus, he should have been equally concerned about the risk he was posing to others.” He graciously said he would start self-quarantining after having tested positve.The author says, “in the countries that have contained the coronavirus outbreak, such irresponsible behavior has not been tolerated, and even could have landed Paul in jail.” For many rule breakers, who refuse to think the virus is a big deal, Paul’s behaviour was unforgivable. He worked as an eye doctor before first being elected in 2012. As a senator, he is an elected official, and people look to him for leadership.The author highlights how Singapore, South Korea and other countries had succeeded in curbing the spread. “Containing the transmission of any infectious pathogen – especially one as contagious as COVID-19 – requires aggressive action. Defensive moves like closing businesses or social distancing are effective only when combined with rigorous, systematic efforts to get ahead of the spread of the disease.” In the above-named countries, “public-health authorities have followed a simple process. First, widespread testing has identified those who are infected even before they show symptoms….. Then, aggressive contact tracing has identified everyone with whom the infected person has interacted. Finally, everyone identified has been subjected to a mandatory 14-day quarantine.”The problem in the US is that people having fevers and trouble breathing had been told to wait for a test. How Paul jumped the line for it is a puzzle. The US does not have anywhere near enough test kits for those who need them, despite Trump saying at the beginning of last month that anyone who wanted a test could get one. The administration promised that test kits as many as 27 million would be available by the end of March. But it failed to hit the 1 million goal. The author points out that “although the US has many of these methods at its disposal, it has failed to deploy them effectively. The Centers for Disease Control and Prevention has trained more than 3,600 disease detectives who are skilled in identifying those infected, tracing their history of contacts, and mitigating the wider risk to the community. But they have been unable to do their jobs, owing largely to early testing failures, which still have yet to be resolved.”Contact tracing used to monitor the movements of an infected for the public's benefit infringes upon the privacy of an individual. It is “costly and time-consuming even in the best of times, when an outbreak is still small. With large outbreaks that have gone undetected because of a lack of tests, it becomes nearly impossible logistically.” Americans are paying the price for Trump’s lack of foresight, his closure of a pandemic task force for no better reason than it was established by Barack Obama – he hates anything that bears his predecessor’s name – and his failure to heed the warnings of a pandemic preparedness exercise. Paul said, “America is strong,” and the Americans are “a resilient people, but we’re stronger when we stand together.” The author says they are stronger when standing together and acting responsibly.America is lucky that it has a federal system, meaning not all power lies with the president, that at least some rests in the hands of responsible mayors and governors, the likes of New York’s Andrew Cuomo. The nation is lucky too that the House of Representatives is controlled by Democrats, who crafted a $2.2tn stimulus package, going bigger and broader than the one already offered by Senate Republicans.But these are small consolations for the US and the world, which needs the leadership only a US president can provide. Instead, people across the globe are looking at the US and comforting themselves with the small solace that they, at least, face only a lethal pandemic, and not the malignancy that is Trump himself.

In El Salvador they just received 9,40o kits to test from the OPS ( WHO) and they have force the population to a lock down. They have sta listed a quarantine of 30 days and have kept the quarantine population in large groups up to 400: people in a crowded space. President Bukele has not consulted local experts to deal with the pandemic. The WHO with members of the OPS ( organización pana America de la Salud) have coluded with Bukele policies regarding the 30 day quarantine . Please if there is anybody reading this please give me your opinion about this what seen to me a disaster in El Salvador . Thanks Dr JJ Morales Canada . MD PhD Surgeon FRCS

The more a country is governed by command and control the better it will be at responding to a pandemic, assuming it does not jail the doctors who discover it.

In a way, the US is a victim of certain freedoms it enjoys that other countries do not. There is almost always a disease spreading somewhere: imagine you find four days later an infected person went through JFK airport. To follow through properly, you should quarantine everyone on his flight, everyone who was in the airport at the same time, everyone on their flights, everyone they met in the intervening days, everyone who works with those people, their children and everyone in their school - that is half of America. Half the time, he would have spread the disease to exactly no-one because it happens to not spread easily or circumstances dictated that it did not spread.

On the other hand, it is well established both in scientific papers and by practice that if everyone wears a mask in public most pandemics can be stopped. The WHO likely knows this but says the complete opposite thing because they don't want people hoarding surgical masks leaving doctors with none - which is ironic because A: they will just do it anyway B: to stop the pandemic, masks made from t-shirts and paper toweling are just as effective. What we really need to do is move from having decision makers who only look for some kind of 'tactical advantage' to those who actually aim to win the war through practical means. It is time to fire the Neville Chamberlains of the World and put some Winston Churchills in power.

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Mass protests over racial injustice, the COVID-19 pandemic, and a sharp economic downturn have plunged the United States into its deepest crisis in decades. Will the public embrace radical, systemic reforms, or will the specter of civil disorder provoke a conservative backlash?

For democratic countries like the United States, the COVID-19 crisis has opened up four possible political and socioeconomic trajectories. But only one path forward leads to a destination that most people would want to reach.

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